tv Q A CSPAN March 24, 2013 11:00pm-12:00am EDT
a widower. who was send us your questions. >> this week on "q&a," dr. director ofins.the the national institutes of health. >> dr. francis collins, can you give us in a nutshell what nih >> the national institute of health is an amazing place. it has a budget every year of approximately $30 billion. half of that goes out to grants in every state of the nation. when you hear about a breakthrough that has happened
in diabetes research or autism or alzheimer's, it is very likely that it came from a university or institute somewhere that was supported by nih. that is what we do. we support the best and brightest to chase after their visionary ideas, and we think we are good at that. as thet is the influence? director, with 27 institutes and centers, how do you influence what goes on? >> it is a very big place. it has 27 institutes and centers. they are various diseases- or organ-instance focused.there is a can start institute, a diabetes institute, a heart and lung institute. each of these is led by remarkable, world-class scientists. they work across the landscape to try to identify what has to happen next in order to advance human health. my role as nih director is to look across the entire landscape and particularly to identify
things that may not be specific to one disease or organ system but could benefit everything, new ways of doing science. since i came out of the genome project, as an example of an project that benefits everything, always looking for examples like that. that is a great and wonderful, exciting thing to be able to do, to be able to try to steer this massive ship in a direction that will have the greatest public benefit in the shortest time. >> two years ago, i did interview with christopher hitchens. it may have been close to his last. he died about a year later. i want to run this clip. [video clip] >> francis collins, who did the human genome project, and who brought it in under budget, we are on opposite sides of the religious debate.
verycame friends.he is a convinced christian. we became friendly debaters, and he has taken a very kindly interest in my case and has helped me have my genome sequenced to look for a more perfect, identifiable match for a mutation that is peculiar to me. >> how did you become friends? >> as christopher said, we started out as debating about the topic of science and faith. in fact, are these world views compatible? for me, they are. as a believer, the opportunity to do science and see god's hands in nature is a wonderful, positive experience. christopher, obviously, has taken a different view and has been articulate in his argument,
on the side of atheism. so we began with the circumstance of having an intellectual jousting about this, and he is a very impressive debater and intellect, but over the course of time, we became friends. i have great respect for the way he could amass arguments and facts, and then he developed cancer, and i reached out to him, hearing that, to see if there was anything i could do to help, because he was clearly in a difficult place, having esophageal cancer, which had already spread beyond its original site, so we met many times in his apartment to talk about philosophical issues, to talk about literature and history, but also to talk about medical issues related to his cancer. >> did you ever think that you could really help him? >> i had hoped that we would be able to slow down what was going
to clearly be a very threatening and almost certain fatal circumstances, given the far- advanced nature of the disease, and i think we may have slowed it down a bit. his initial diagnosis seemed that he will only have a couple months to live, and he had 1.5 years. he was a pioneer on the leading edge and went to st. louis to have his genome and his cancer sequenced to see if there was something in the cancer cells that would have led to a different selection in cancer therapy, and, in fact, it did. did that result in benefits? hard to be sure. this is n=1 science.which most scientists would tell you is a difficult way to draw conclusions. but he was intensely interested. it was an experience. he and i went together to see what we could do in his particular case, and he wrote about it in his columns in
"vanity fair" magazine and then , by thati think mouthpiece that he had to the world, he was able to share some of the excitement about where cancer research is going. it is an amazing time right now. >> i know you were running the human genome project. what does that mean? what does "genome" mean?>> a word people disagree even whether it should be ge-nome or -nome. it is all of the dna of an organism. that is the hereditary material that gets passed from parent to child that carries all of the hereditary information. it was figured out back in 1953 to be a double helix. it carries that information in a remarkably elegant and
deceptively simple way with just four chemical bases. it is a book written in a funny language with just four letters in its alphabet. we abbreviate them. a, c, g, and t. many people think we should have labeled them a, b, c, and d. and all other organisms use that same language, that same concept evolution acts upon those genomes over hundreds of millions of years to result in the enormous diversity of species around us. >> heredity, how important is that? >> heredity is enormously important from almost every perspective. certainly, we are all interested in it, aren't we?in terms of our families, the characteristics we see in ourselves. for me, as a physician, heredity is hugely important. almost every condition is a mix of nature and nurture.
the nature part is heredity. if we are talking about cancer or alzheimer's disease or diabetes, heredity is the strongest known risk factor for all of those conditions. that is operated on by the environment and health choices. the genome, now revealing a lot of its secrets to us, is helping us to nail down what that heredity looks like and how we may learn enough about it to influence outcomes, so if you are born with a high risk of alzheimer's, maybe there is something you can do about it before you get the disease. >> when you sent christopher hitchens, what did he do in st. louis? >> he was examined by the cancer experts. they conducted dna analysis from his blood, and that could tell you the dna he was born with, and then they could look at the specific dna in the cancer cells.cancer is a disease in the
genome. cancer comes about because of mistakes in the dna you are born with, causing them to grow when they should not, and in his cancer genome, they found a dozen or so mistakes that were acquired during life that were driving those cells to grow, and at least one of those not previously described suggested the possibility of using a therapy you would not normally have contemplated for esophageal cancer, so there was a chance to try something that was rational, sort of evidence-based, a designer drug based upon the detail. this is where cancer is going. the idea that cancer is one disease is very yesterday.-- the goal that many of us have is to get to the point where everyone has that detailed information.
you can then look at a menu of therapies and do the match. for this person, this drug is likely to be beneficial, this one probably not, and then we would move from our current approach to cancer, which is pretty much a generic, one size fits all, to something personalized or precision-based, where it really is designed for that person. >> when did you first meet him? christopher five or six years ago. he was during a debate with a famous theologian. i went to listen to the debate and went to dinner afterwards, and we got into a fairly intense argument about whether or not the concept of right or wrong has any meaning, if you do not accept the idea that there is something greater than us behind all of this. >> so when did you get involved in this cancer program? >> shortly after he was diagnosed, which would be about
two years ago. >> did he ever say how much it cost him to get from diagnosis to the end? >> i do not know.>> did the nih paper that? >> -- pay for that? >> he enrolled as a clinical participant in a trial. we had no specific treatment for christopher, but if he was interested in a trial and wanted to sign up, he was able to do so. >> what does that mean? >> an important question. lots of people are facing situations where we do not have great answers, where it is cancer or diabetes or alzheimer's disease, and we at nih run hundreds, in fact, thousands of clinical trials where we are testing out some new, experimental therapy. you do not know if it is going to work. the only way to do this is to do this in a careful, rigorously observed fashion.people who are interested in that can go to the website.
there is clinicaltrials.gov, where people can go to see what is available for their conditions. what are the conditions that you have to match in order to be enrolled in the trial, and if they want, they can sign up. they go through a process of informed consent so they know what the benefits and risks are, and they decide whether to participate.that is how we make advances in medical research. this is a partnership between patients willing to enroll and investigators who have new yous.>> i want to show some statistics that came out of the cdc, down in atlanta. you have anything to do with that? >> we work very closely with the cdc. we are parallel. we are sister agencies within health and human services, but we work closely with them. >> these are the 2011 statistics on the screen, and it shows the number of people who died in the united states, at 2.4 million, and the life expectancy is now 78.7, and the infant mortality is now 6.15 births per 1000, but
this is what i wanted to show. heart disease, 597,000. cancer, 574,000. stroke, 129,000. accidents, 120,000. alzheimer's disease, 83,000. diabetes, 69,000. influenza and pneumonia, 50,000. and then, suicide, 38,000. those numbers on heart and cancer, have they not been there forever? >> actually, no. those numbers are too high, but heart disease, we have seen death by heart attacks drop by 60%.that is in the last 40 years. those numbers would be greater. why is that? i will take some pride in saying that nih, by supporting research, going back to massachusetts 60 years ago, were were many things,that
found were the risk factors of and we led to huge advances in public health, including statins, and a variety of other interventions.we can unclog the heart. 60% drop in deaths because of that research. we have ideas about how to go further. cancer, certainly, way too many die from this disease, but the death rate has been dropping about 1% each year for the last 15 years. we are on the right part of the curve, but we want it to go down faster, and these new developments, particularly with cancer genomes -- we could move into a new space that is designer that could be more effective. >> how much of it is diagnostic, instruments and the ability to see the disease before it develops, and how much of it is
medicine? >> it is all of those, and we need to have three things. we need better prevention to keep people from getting cancer in the first place, and we have to work harder to come up with research to encourage people not to smoke, or if they started smoking, to stop. that is the single most actionable cause of cancer, and we still have not succeeded.20% of people in this country still smoke cigarettes, and that is putting them at enormous risk.for cancer, for heart disease. >> is that what got christopher esophageal cancer? >> it is hard to say. he was a heavy drinker and a heavy smoker, both factors, but his father had esophageal cancer, so heredity, as well. it is the old statement that genes load the gun.environment pulls the trigger. he may have had both of those going at once. >> i have a friend who smokes, and i chide him about smoking,
and just yesterday, he sent me a link to a woman who has smoked and is 100 years old, as if he is saying, "i can live to be 100." how do you know that smoking will definitely cause cancer? >> that is absolutely incontrovertibly proven without a shadow of a doubt.it has been now for 30 years. the fact that people are denying that really means they have not looked at the data. the data leads to that conclusion. there are recent papers in "the new england journal of medicine."it looks at smokers, their overall longevity. it talks about cancer, heart disease. someone who smokes lifelong on the average has lost 10 years of life, 10 years. >> every single one?quacks on the average. -- >> on the average.
this is an epidemiological statement. if you stop, you get most of it back. if you stop at age 40, you get eight years of those back. people listening, if you have gone through your whole life like that, there is a lot of opportunity to turn this around. it is not like, i am a smoker, i am doomed anyway. not true. you have to figure out how to take advantage of the many ways that are now available to help you stop. nih has many of those. you can go to our website and read about programs that are proven to be successful. some things are tough. nicotine is addictive. these are not just people not showing any willpower. it is really hard once you have been a long-term smoker.>> did you ever smoke? >> i never have. >> my mom smoked one pack a day and then quit and then got lung cancer, and she said to me, "i did not get lung cancer because >>smoked, because i quit." you know, cancer grows. when somebody has a diagnosis of cancer,
it likely started six or 10 years earlier, but it takes that long to lead to enough of a mass to detect it, so i am sure that it started a couple years before >> there are several sides of dr. francis collins. one of them is -- we have some footage here of you at a graduation at the university of michigan, back in 2007. were you giving a graduation address? >> i was. >> let's look back. [video clip] >> this is a song that probably after today, you will never again want to hear it. this is a rush, playing my guitar at chrysler arena. [laughter] whoa. someone, lock the doors.i do not want this to slip away.
this is a song of the student experience, except for the last sentence, which is for me as a genetics professor. so here we go.♪ ♪ ♪ i came i bought the books lived in the dorms followed directions i worked, studied hard, made lots of friends who had i crammed s they gave me grades and may i say, not in a fair way but more, much more than this, i did it their way ♪ [applause] >> now why did you do that?
>> oh, goodness. i grew up in a musical family, and music has always been for me a break from the seriousness of life, whether it is a joyful song or a silly song.even a sad song. it is a way to use another part of your brain and relate to people, and as a medical school professor at the university of michigan, i also learned that medical students are not so easy it helps toerested. have something a little surprising. that song originally was one i would sing for medical students, when it seems they were reading their newspapers or starting to sleep or maybe not show up for class at all. >> you were home schooled for how long?>> until the sixth grade. quacks who schooled you during those years? >> my mother, a remarkable woman. my mother had a master's degree from yale, which is where she met my father. it was unusual for her to be in
graduate school at yale in the 1930's. she decided that her four sons, and the youngest, would be better served by her educational methods than by various public family traveled around between north carolina, long island, and virginia. i think she was right. she was remarkably gifted in it's what that spark. you really want to see education represent. i learned to love learning because of the way she introduced me to topics. it was very chaotic, i must say. >> itat was the day like? was totally unpredictable. there was no lesson plan or curriculum standards. my mother would say, ok, what is interesting today, and some days, it would be mathematics, and we might do only mathematics for three days in a row because it was interesting, and then it would get tiresome, and she would say, let's talk about history and talk about what the significance of that event was, and she was a playwright and
very interested in languages. we did a lot of study of languages, and she would say, "ok, here is a word. do you think that is derived from greek or old french or latin?" and i got pretty good at that, and we would go to the unabridged dictionary and look it up.>> where was this? >> they bought a farm in the late 1940's in virginia. he was teaching drama. but he and my mother liked the idea of this simple life. they kind of tried to live off of the land. that did not work so well, so it is good that he had a day job,at the college, so i grew up on a farm, and it was hard work sometimes trying to manage all of the livestock and crops and everything, but it was a great way to grow up.
>> and your brothers were home schooled? >> yes, all four.they turned out ok. my oldest brother got a phd in russian, talk for a while, and then is now a realtor. my second is a businessman. the third is a teacher in virginia. >> at what point did you get interested in chemistry or biology? >> it took a little while. i had a little interest in science, so i was one of those kids glad to have a chemistry set and would try to blow stuff up, which is what most boys do with their chemistry sets, but it was a dabbling thing. it was really 10th grade. by that time, i went to public school.we moved into town. my grandmother had a stroke, and we moved to stay with her in stanton, virginia. and my mother decided she had done enough homeschooling. i had her foundation of loving learning, and then for science, i had in this public school in
stanton, virginia, a teacher who taught chemistry, who absolutely inspired me to see what science was about and led me to believe that that is what i wanted to do.our first each of us aave sealed black box. there was something inside, and we did not know what it was, and he asked us of all of the experiments we could do to try to figure out what was inside that box without opening it, and it was a perfect metaphor of what science was about, and i had never been challenged in that way. i had dabbled in science.it was sort of memorizing stuff, descriptive parts. i was not so interested, but this was use your brain. it is a detective story. wow, that sounds like what i want to do, so i decided right then and there that i wanted to be a chemist. >> how long were you an atheist, and why? >> i grew up in a home where it
was not considered important or relevant, not denigrated, so when i got more interested, majored in chemistry, went to graduate school, studied quantum mechanics, i was looking at what was the need for god there, and it was a community.i became more of a reductionist. anything can be reduced to chemistry principles. surrounded, as i was in that community, that was the standard model people took anyway. by the time i was a second year grad student, i was an atheist. i did not see any need for god. for those that expressed an interest, i did not even feel it was worth talking about, but then something happens. i changed my scientific direction because i felt i had missed out on the excitement of recombinant dna was coming along.there were
principles that sounded interesting. , sent a real career plan i decided to go to medical school. >> where did you go? >> university of north carolina. >> prior to that, you got a ph.d. at yale, and prior to that? >> undergraduate at the university of virginia. i had been married and had a daughter. this was a lot of things to packed into a few years, and then i had to go to medical school, but i landed in chapel hill, and i embraced that science immediately as what i had been looking for. and the part of medicine that particularly appealed to me, maybe because of my attraction to mathematics, was dna, the genetics that underlie human biology, so i became attracted to that even as a first-year >> back in 2006, use oak at politics and prose
-- you spoke at politics and prose. you spoke about a book you had written. let's listen in on what you had to say. video clip]>> i believe that god created the universe, that energy that screams out for an explanation about how something can be created out of nothing. not just having some rocks and some gas floating around the universe, but the intention to have creatures, including one type of creature with whom he could have a relationship. that would be us. i believe god chose the mechanism of evolution in order to accomplish that goal. >> i looked for the strongest criticism i could find of you on amazon, where they have all of those reviews. i want to read the paragraph to you and get you to react, because you got a lot of positives, but you got a lot of negatives too, which i know you
are used to. it is a not signed. customer. it does not give the name of who wrote it. this was back in 2006. "one would hope that it would be immediately obvious to collins that there is nothing about seeing a frozen waterfall, no matter how frozen, that offers the slightest collaboration of the doctrine of christianity, but it was not obvious to him, and it will not be obvious to many of his readers -- if the beauty of nature can mean that jesus is the son of god, then anything can mean anything." so what is it like as a scientist, convert to christianity, and then get slapped around by people on amazon? >> let me reflect on what that waterfall comment was all about. >> yes. >> as i said, i went to medical school an atheist and emerged a believer. how did that happen?
a lot of it was sitting on the bedside of people losing their lives and realizing i had not thought deeply about it and not looked at the evidence, and i was supposed to be a scientist, making decisions on the basis of evidence, so i began my own search somewhat reluctantly and realized that probably atheism is the least rational of all of the choices, given that it says "i know so much that i can exclude the possibility." and i do not know much about what is outside of nature. given that, atheism is ruled out as a system that a thinking, rational person could adopt. obviously, people can adopt it. i am saying it rather strongly. agnosticism, on the other hand,
the idea that i cannot know, is a defensible position, but for me, it was kind of a cop out. and what i began to realize is that their arguments, and they have been put forward by people down through the centuries that might lead you to the conclusion that belief is more rational than disbelief.although it is not provable. therefore, over a couple of years of wrestling with this and beginning to recognize that the world religions have a lot in common, but there is something very special about christianity and the person of christ, and that is an extremely well documented -- i became somewhat against my own best interests as a scientist a believer. >> have you ever doubted that since? >> oh, sure. every believer has to have doubt is not the opposite of the leaf. it is an element of belief, doubt, but doubt is a good thing because it lets you know what you need to dig deeper into.why is this bothering me?
what have other people facing this come to understand that helps me? >> what impact has it had on you as a scientist in that scientific community that you outwardly acknowledge yourself to believe?>> i am not that different. 40% of working scientists believe in a personal god to whom you might pray. that is not hypothetical. that is a theist perspective. scientists do not talk about that. i have written a book to speak about this because of a desire to particularly help those that are wrestling with the issues to see that there are ways. that comment from that viewer about the waterfall i guess is an easy one.that was simply my own story of the moment when i decided to take the leap into faith. >> how did that go? influenced by a
particularly beautiful scene in nature. i would be the first to say that in no way proves there is a creator that has an intelligence and a mind -- it was a moment of having all of the distractions that get in our way stripped away, and that was the conversion. >> where was that? >> in the cascade mountains. >> who were you with? >> i was with a friend. we were on our way to a genetics meeting, and we took time to ixplore, and it was beautiful. had never been to the cascades. >> did your friend know you were having a conversion moment? >> he had no idea. it was personal. it was not something i was sharing with the guy that was there with me. >> so what did you do when you had that moment? >> i had this very clear sense of personal commitment and a realization that i had crossed the bridge into becoming what i had thought i would never become a believer in a personal god.
>> was there anything else going on in your life that may have >>lped you get to this point? i think this realization, as a physician, life and death is all around you. this is a really important question. this is not something to put off indefinitely as i may be had planned to do. here, as a scientist, i was looking at all of these interesting things about how nature works and how human biology is wired, but what is a more important question than if there is a god? it seemed like one that needed an answer. >> going back to christopher hitchens, where he may have changed his mind at the end.he was telling us he was not going to change. he did not believe. >> i made no effort to convert christopher hitchens in the end. i thought that would be disrespectful.the situation he was in,
i was trying to serve as a physician to someone who had cancer. it would have been inappropriate to try to use that moment to try to impose my perspective on his. we had interesting jousting back and forth, much of a humorous. >> how close to his death were you able to talk to him? >> i saw him quite a lot until the last three months, when he went to texas to do this proton beam therapy and never got well in thoseo come back. intervals, i did not see him much. >> let's go back to nih?how big is the campus? >> it is an amazing place. about 320 acres in bethesda, maryland, and on that campus, there are about 17,000 people, amazing people. about 5000 to 6000 of them have doctoral agrees, and they are experts, on almost anything you can think of, from basic science to clinical research. we also have on that campus the largest research hospital in the world, 240 beds, and the people in that hospital, are there because they are all part of a
clinical trial of some new approach to understand a disease that we do not have a good answer for, but, again, while that is an amazing place, the funds, the vast majority go out in grants to the best and brightest investigators in stanford or the university of illinois or massachusetts general hospital or all over the country, where those visionary things are happening, and we are on this remarkable pace right now of accelerating knowledge about how how life works. clicks on a given on a that is $26 -- >> given year, that is $26 billion. how do you control that money? how do you
know that people are not ripping you off? there are people who have gotten this money and have not done anything with it? >> our system is rigorous. if you want money from nih, you have to write up a grant proposal, putting forward what you plan to do for the next year's and defending that that would be useful and that it is possible you might actually be able to do it. it is then reviewed by a panel of experts in your field, in the most rigorous, peer review system in the world, and then they look at a whole bunch of grants that have come in that cycle, and they score them and give them a priority.at this point, we only fund about one out of six, so if you come with an idea that is not very well baked, you are not going to get dollars. you are in the very best of the best if you get that award. >> can you call up one and say, "i want you to give tom smith the grant"? >> absolutely not. that would be totally inappropriate.that would be the end of my career as the nih director. the way it works, the peer review systems sets the priorities, and then there isa
second level of review, where there are senior people who looked at the portfolio of the institute and say, "you know, we have an area that does not have enough going on. this grant does not quite make the cut, but i think we should fund it anyway, and we have a maybe we-up over here." don't need 19 grants on angiogenesis. the lucky ones get funding. then, you have to report to us every year. and if you are deviating in some way or going down some pathway that is inappropriate, you will hear from us.>> the 27 institutes and centers, which one is the biggest? >> the biggest is the cancer institute. right behind that is the infectious disease institute, which oversees hiv/aids. right beyond that is the heart and lung area. blood diseases.
not too far down are others like the diabetes institute, the aging institute, the mental health institute, the neurological diseases institute, and then down the line. >> speaking of diabetes, you have a couple of times appeared on the show of stephen colbert. here is a clip. there is a connection to diabetes. this is from a couple years ago. [video clip] >> three years ago, i was 30 pounds fatter. >> you are super fat. i wanted to say something about that. [laughter]you are super fat. yes. risk for diabetes, and i did not want to get that disease. with a change in diet and exercise -- can i show you? >> sure. >> this is called fat.isn't that lovely? this is just 5 pounds. i lost six of those.>> you lost
30 pounds? that looks delicious. [laughter] >> when i saw that, my first question was if you stacked up six of those, where would you put that on your body? that looks huge?>> bodies are pretty good at packing this step away. -- stuff away. it is not one big lump. it is all over you. it is shocking and impressive. that is why i brought that impressive show and tell. >> why did you go on that? because you know he often skewers people.that is part of his act. >> really? i had not heard that. art of my job is to be an educator about medical issues, about human health. -- colbert reaches an audience that otherwise would not be reached,
and he kind of like to bring scientists on, because he has got an inner geek himself, so it was a chance to talk about our national epidemic of obesity, which is resulting in an epidemic of diabetes. this came at the time hbo was doing its documentary onobesity , which we at nih had a part in. giving it the colbert bump.>> from all appearances, and this is a shallow statement i am about to make -- it does not look like this nation is getting any thinner. >> there is some progress being made. i am particularly interested in some cities, particularly in philadelphia, where mayors have decided this is an opportunity, and we have to look at it as a community issue and not just blame the individuals who are struggling with their weight, and that means providing safe places for people to exercise, bike lanes, thinking about the food deserts, better efforts in
often times,es. they have not been ideal for the nutrition our kids need. a lot of the problems that worry us most is obesity in children. all of these things in many ways are community issues. we cannot solve our obesity issue with any single thing. we cannot do it simply by educating people about what they should eat or national policies. it has to be everything. >> why is this such a heavy nation? >> it is a combination of things. it has been growing on us, literally, over the past 30 or so years. some of it is the addiction to screen time rather than outdoor time, which has greatly reduced burning calories.some of it is that food has gotten very calorie rich and very cheap. there are some things we put in our mouths that are empty softries, sugary things.
drinks give you basically no nutritive value, and do not even suppress your appetite. this is a big issue that has grown over time. >> what do you think about what the mayor of new york has been doing?>> i think the mayor is conducting useful experiments to see what is it possible with government policies to try to encourage public-health changes that are going to be better for our nation and save us in terms of health-care costs.he gets accused of being heavy-handed and conducting a nanny state. but if we are serious, if obesity is threatening to make this the first generation where our kids do not live as long as we do, it seems like there is a responsibility. >> how tall are you? >> 6 feet, four inches.>> how much did you way when you started your diet? pre-k's -- >> i was 213 pounds. >> are you still 30 pounds less? >> yes.>> where did you get your weight that you had to lose it? >> i was a junk food addict.
honeybunch, pastry. that was something i could not pass up. >> for how long? >> most of my adult life, and it crept up on me. i had mine dna analyzed, and we -- as part of writing a book about the future of medicine. and we are analyzing and discovering the hereditary part. it turned out my results suggested i was at a higher than average risk for diabetes, and that was part of the wake-up call that made me finally decide to take charge. >> who can have their dna tested?>> anybody, now. there are companies on the internet. you have to be very careful looking at what they are offering and what their truth in advertising is, but you can have your dna analyzed for a couple hundred dollars and look at what your risks are and what you might want to do about it.>> how can you found out which -- find out which dna companies are the best? >> you can read my book, and you can also look at their materials and assess which of them seem to be giving you scientific evidence, what are their
citations, why do they point to as far as the basis on which they make these recommendations, but i do not want to promote this too much because this is still early days.most of the kind of genetic analyses that we can do change your odds a little bit up or down, but they are nottelling the whole story. there is a lot there. >> what did you learn about your medical genome? >> i was worried about the alzheimer's diseases. that is where we have a pretty impressive ability to make predictions based on one a gene, reluctant at first about whether i even wanted to know that one. right now, if you are high risk for alzheimer's, there is nothing we can do. i eventually decided to look, and it was ok. i had reduced risks of some other things. i was glad about that. all of those things could be misleading because we are still
scratching the surface of understanding heredity. what i can see now is a small fraction of what is there.>> let me ask you about breast cancer. the numbers, you probably have them, but i think from reading, more men get prostate cancer than women get breast cancer. >> that is true. >> why do we not see pink ribbons for prostate cancer, and we see all of this attention on breast cancer?there are no marches, almost nothing on prostate cancer. >> there is a bit. the prostate cancer foundation that very much promoted. prostate cancer is generally a disease of older men. prostate cancer also is less frequently lethal. so, perhaps, it is not seen asa public health emergency in the way of breast cancer. but there is a lot of advocacy.
it plays a role in the visibility of certain conditions. it is not always connected in terms of the seriousness of the problem. i mean, if you look at diabetes, diabetes kills a lot of people, from heart attacks, from kidney failure.it blinds people. but does diabetes have the same visibility as breast cancer?it does not seem to, in part because of the urgency. just how affective the advocates have been. >> how much money does the national institutes spend on breast cancer and prostate cancer? >> i do not know the numbers, but it is a lot. >> breast cancer more than prostate? >> i bet they are fairly close. this is also something that is important, in terms of how we allocate funds, we are learning about cancer is probably our designation of cancers of the organ in which they arose is not very helpful. what really matters is which genes are active. somebody studying breast cancer may make a discovery that is more helpful for prostate cancer
than breast. we need to think about it in a different way and not try to parse it out in different >> as the head of the national institutes of health, do you appoint the heads of the national institutes? >> they are appointed by the secretary of health and human services, kathleen sebelius, but i have a very heavy role in making a recommendation, and i do so generally by organizing a search committee of the best and brightest people in that field to try to identify the perfect person, have them go through all of that vetting, and then have them make a recommendation to the secretary. it is not easy. we cannot pay them probably more than a quarter.-- quarter of what their market value would be. you can barely squeeze up to $300,000. very few of our directors are at that level.most of them could the college presidents, or executive vice deans of medical
centers. they get paid three or four times that. >> why did you get picked for the human genome project? >> i have wondered that.>> and who picked you? >> the nih director, who died of cancer, of a brain tumor. she reached out to me very early in the project. it started in 1990, and the first director was james watson, of watson and crick. i was at the university of michigan. i had been hunting for genes that cause diseases, including for a disease called neurofibromatosis.i had set up a small genome center at michigan, with nah support. but i was not expecting to get a call to come to nih and lead that effort, and i initially said no because it did not seem like something i was ready to do. my mother, who i told you earlier was such a wonderful influence on me, she told me that there was one thing i must
always avoid, and that was becoming a government employee. whatever else you do, do not do that. i had a conversation with my mom about this. >> how long were you with that project? >> so i came in 1993 and stayed until 2008, but all of the goals of the human genome project were a year and a half early, in 2003. t cost about $400 million less than planned. it was a $3 billion budget, and we did it for $2.60 billion. a federal project, ahead of schedule, and under budget, not ms. healy was a republican working for a republican president, and you were picked by her, and then barack obama picked you to be the head of nih. how did that happen?>> i am happy to say that even now, in
this hyperpolarized environment , medical research remains one of the few things that is non-partisan.may it always be that way. that is something we should value if we care about our health and that of our family and our friends and our constituents. this is not something where republicans and democrats generally differ.they do not even differ now. >> back in 2009, the president in his brief made this announcement, and then i want to ask you what happened. [video clip] >> we knew the work that you do would not get done if left solely to the private sector. some research does not lend itself to a quick profit, and that is why places like the nih were founded, and that is why my -- isistration is for the making a historic commitment to research and the pursuit of discovery, and that is why we are announcing we
were awarded $5 billion, that is with a b, in grants through the recovery act to conduct cutting- edge research all across the america. >> assuming you were in the room, what happened to the $5 billion? >> it went to accelerate some very exciting science that otherwise would have taken a lot longer. we have talked about cancer. our ability to know for 20 different cancer types exactly what is the menu of genetic mutations that can cause these cancers, was greatly accelerated by part of that $5 billion. our ability right now to say within the next few years, we may have a vaccine for influenza that works for all of the strains, so you do not have to get your shot every year. if you get your shot, you were covered. that was greatly accelerated, and hundreds of others that would have taken time were stimulated by the recovery act. it came at a great time, because from 2003 until 2008, the budget for medical research at nih was basically flat, which means
inflation was eroding it, so their ability to chase after visionary ideas was being diminished. this tapped into a great, pent up opportunity to do visionary science, and it happens. >> who made the decision on where that money would go? >> across all 27 institutes, a team, working together, at remarkable speed, because this all came together quickly.we tried to identify what would be the best way, across many different diseases and projects , to spend these dollars. i would defend every penny. >> how fast did you get the money out there? >> we did it in record time. i think we knew in february that the money was coming, and then had to be couched in terms of new projects, and applicants had to write grants, and they had to be reviewed, and most of the grants were out of the doorby
september. >> we do not have much time left, and i know you need more time to talk about this. a couple of weeks ago, february 25, if you picked up "the new york times," there was a story that said "connecting the neural dots." in setting the nation on a course to map the active human brain, president obama may have picked a challenge more daunting than afghanistan or finding common ground with his republican opponents. as we record this, it has not been announced, but i did not see your name in this story. are you involved? >> oh, very much so. this is an exciting opportunity. this is the kind of visionary project that is right on the edge of what is possible, which is what nih should be about. we have the ability to understand the brain in certain ways, but there are many areas where we do not have a clue about the way it works.
for instance, we can record individual brain cell, a neuron, and we can see the whole thing, but there is this enormous gap in between about how the circuits in the brain function in order to be able to move my hand or to be able to look at you and process that information, or to lay down a memory. we do not know how that works. with technology, yet to be invented, so a lot of this is going to be nanotechnology, what we need to do is be able to record maybe hundreds of thousands of brain cells at the we would be able, therefore, to understand how these circuits work. that is the brain activity map that is being talked about. very early days. we do not yet have an idea about milestones and costs. but it is getting to be a very exciting moment to put something
together that we could not have thought of. >> the article says it is going to be hard to do that than the human genome project. >> i agree.the human genome project had a clear endpoint. -- could read it out, and no know we were done. this brain map, it is hard to say when you would complete the effort because the brain is enormously complicated. 100 trillion cells, all of the ways they interact with each other. we will never be able to say, "we got it."it will be an ongoing effort. we really need to nail down what are we talking about with the activity map, not that we will reveal all of the secrets, but that we will reveal some of them in an ordered away and that nails down some of those goals, and the timetable. >> when will it start, and how much will it cost? >> still to be discussed. we hope to start at least some pilot efforts in the next year. i cannot give you a cost at all
until we have a chance to lay out what the plan will be.that is probably at least a year away. >> how long are you going to do this job? >> i am having fun. the budgetary issues makes it less fun than if we were in a growing phase, and i see young scientists looking at the situation and wondering if they can stick it out through thick and thin, because there is a lot of thin right now.but the science is exhilarating. i was appointed by the president. i am still there for the second term. , the director of nih turns over when the president turns over. i would assume i have a little less than four years to go. >> for you, the most exciting possible discovery that you are aware of coming along in your work? >> it is very hard to pick one. i do think what is happening in cancer right now because of the secrets that are being revealed from the tools that basically came out of the human genome project i did not think in my
lifetime we would learn, and with direct implications to figure out how to prevent and treat this disease -- cancer. >> do we waste money in medical research? >> if there is waste there, i have not found it. certainly right now, we are only funding one out of six ideas that come to us. we waste ideas because we do not have the resources to support them. if somebody thinks that somehow medical research is rolling in the dough and we can cut back on it without consequences, come and spend a day with me and listen to what people are they are having trouble keeping their labs going. there are graduate students wondering if they should continue down a course when they see their mentors struggling. i do not see waste here. i see a lost opportunity. >> going back to that graduation class at the university of
michigan, and i want to thank you for joining us today, dr. francis collins, the head man at the national institutes of health, but here you are in a different setting, and thank you for joining us. >> it has been great being here. >> ♪ but now, my fine, young friends, now that i am a full professor where once i was oppressed, i have now become the cruel oppressor and maybe you will see the double helix as a highway and do ♪t best and do it my way ?
♪ pplause] well, i am just a man, what can i do? open your books, read chapter two and if it seems a bit routine, do not talk to me, go see the dean you cannot fail, to the victors hail, and go do it your way ?♪ [cheers and applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> for a dvd copy of this